CS FOR SENATE BILL NO. 22(FIN) "An Act adding birthing centers to the list of health facilities eligible for payment of medical assistance for needy persons." RICHARD BENAVIDES, STAFF, SENATOR BETTYE DAVIS, explained SB 22 would add birthing center fees to Medicaid reimbursements. 9:03:07 AM Co-Chair Chenault asked about fiscal note #2 by the Department of Health and Social Services. He noted that there is a great deal of uncertainty in calculating the cost differential between birth center and hospital births. Mr. Benavides explained problems that result from complicated births. Representative Hawker asked if birthing centers are eligible for Medicaid. Mr. Benavides replied that if they were approved they would be. Representative Hawker suggested that this should be figured out first. 9:05:29 AM JERRY FULLER, MEDICAID DIRECTOR, DEPARTMENT OF HEALTH AND SOCIAL SERVICES, explained Medicaid services and how approval is obtained. He explained the intent of the bill. Representative Hawker referred to spies and the risks of adding this authority in statute if Medicaid says no. Mr. Fuller clarified the intent of the second part of the amendment. The language needs clarification. Representative Hawker suggested legal clarification regarding an alternative to existing Medicaid coverage. Mr. Benavides pointed out that that was the intent, so it is not open to a need to use general funds. Representative Hawker emphasized that it is unclear and needs work. 9:09:29 AM Representative Croft noted that in the statute "if" is the key to understanding the intent. He implied that it is clear that birthing centers are a health facility only if the plan is approved. Representative Hawker asked for legal clarification on the state and federal regulations. Mr. Benavides suggested that there is no such person who could speak to both regulations, and the CS takes care of the problem. 9:11:11 AM Representative Holm inquired if the state, by reference, is giving birthing center stays equal status to a hospital stay, especially regarding C-sections. He wondered about liability in that situation. Mr. Benavides replied that birthing centers work out that situation with the closest medical facility and assume that risk. Representative Holm restated his question. Mr. Benavides said birthing center births are comparable to births at a hospital. Mr. Fuller added that he does not believe there is any difference between liability of home births and birthing center births. Representative Holm said it indicates that there is a possible financial burden on the state. 9:14:56 AM Representative Kelly asked if the law is necessary for the program to continue. He asked why the law is needed in advance of program approval. Mr. Benavides replied that nothing can be added to Medicaid programs unless it has been approved by the legislature. Birthing centers are growing in Alaska and this is an attempt to make them eligible for Medicaid services. Representative Hawker referred to the optional services list and opined that the bill does not address it. Mr. Benavides agreed. Representative Croft agreed with Representative Kelly's interpretation about which came first. He opined that the bill does allow for an option which is not currently offered. 9:19:19 AM Representative Kelly asked if this bill covers mid-wife delivery. Mr. Benavides explained that the bill does not address home birth services, because that is already covered. It addresses the birthing facility, which is currently not covered. Vice-Chair Stoltze noted that it contains a zero fiscal note with red flags. Co-Chair Meyer wondered if a letter of intent would be helpful. 9:21:46 AM Representative Hawker noted that Medicaid is already paying for more than half of all births in Alaska. He said he is not in favor of expanding this service. SB 22 was set aside for later consideration. 9:23:17 AM CS FOR SENATE BILL NO. 22(FIN) "An Act adding birthing centers to the list of health facilities eligible for payment of medical assistance for needy persons." 9:59:54 AM Representative Hawker requested a legal opinion about the fiscal notes and an assurance that this bill would do no more than offer an alternative to the existing Medicaid obligations. SENATOR BETTYE DAVIS, sponsor, stated that the manner in which the bill is written, will give the department an opportunity to ask for an amendment to the state plan. It does not obligate the state to do anything. 10:01:24 AM STACY KRALY, ASSISTANT ATTORNEY GENERAL, DEPARTMENT OF LAW, (via teleconference) explained that testimony by Senator Davis was correct. There would not be a federal Medicaid match unless the services were authorized under the state plan. 10:02:17 AM Representative Hawker reiterated his query. He wondered if this legislation would create a new, expanded Medicaid service. Ms. Kraly replied that the way that the proposal was being offered, it would be in lieu of a hospital stay. It would not be an expansion of a service, there would not be an additional service, but rather an offset. 10:03:42 AM Senator Davis added that the bill is an opportunity to provide a choice of using birthing centers for delivery. The facility fee would cost less than it would cost in a hospital. The services would be paid for regardless, and would not obligate the state for any other monies. She stressed that nothing will happen on the bill at this time, and that she expected members to pass the bill. 10:05:56 AM Representative Foster MOVED to report CSSB 22 (FIN) out of Committee with individual recommendations and with the accompanying fiscal note. CSSB 22 (FIN) was REPORTED out of Committee with a "no recommendation" recommendation and with a zero fiscal impact note by the Department of Health and Social Services. 10:06:40 AM